Healthcare Provider Details

I. General information

NPI: 1689413650
Provider Name (Legal Business Name): WOUND SAVERS OF CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E ORANGETHORPE AVE STE 200
ANAHEIM CA
92801-1144
US

IV. Provider business mailing address

1100 E ORANGETHORPE AVE STE 200
ANAHEIM CA
92801-1144
US

V. Phone/Fax

Practice location:
  • Phone: 714-932-8931
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SIEGHART PORNHOLD
Title or Position: OWNER
Credential: MD
Phone: 714-932-8931